Provider review
Willow review: an honest price ladder, and two claims the trials contradict
Willow does two things this market rarely does. It names the pharmacies that make its medication, and it publishes a price for every dose. Compounded semaglutide is $299 a month, and the ladder says exactly when that changes. The problem is what it tells you about stopping and about muscle. Its pages say some people keep the weight off after stopping, and that there's no link between these drugs and muscle loss. The trials that measured both found otherwise.
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Visit WillowA seller that shows its whole price ladder and names its pharmacies, then tells you two things about stopping and muscle that its own drugs' trials contradict.
Worth trusting if
- You want to see what every dose costs before you start, including the top of the ladder
- You want the pharmacies that could fill your prescription named, with addresses
- You want a monthly plan with no prepay block and a stated cancellation window
Be skeptical if
- You're counting on keeping the weight off without the drug, based on what the site says
- You want a tablet with evidence behind it, because no trial has tested this route
- You live in one of the 14 states it doesn't list as served
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Compounded only
Phase 3 trials
Named
None found
Provenance
What Willow actually dispenses
Regulatory category is the axis consumers are most reliably misled about, so it comes first. Every product below is sorted by what it legally is, not by what it costs.
Prepared by a state-licensed pharmacy against a prescription for a named patient. Compounded preparations are not FDA-approved and are not reviewed by FDA for safety, effectiveness or quality.
- Compounded semaglutide injection, once weekly — $299 a month at every dose up to 3.5 mg, and $399 at the 7 mg dose.
- Compounded tirzepatide injection, once weekly — $399 a month through 6.375 mg. The price climbs from 8.5 mg and reaches $549 at the 17 mg top dose.
- Compounded semaglutide tablet, dissolved under the tongue daily — $299 a month at every dose on Willow's cost page. Its tablet guide quotes up to $399, so ask which applies to you.
- Compounded tirzepatide tablet, dissolved under the tongue daily — $399 a month at 6 and 10 mg, and $459 at 20 mg.
- Compounded semaglutide and tirzepatide combination tablet — $399 a month at the lower strength and $459 at the higher one.
- Compounded NAD+ injection — $199 a month, the lowest-priced plan Willow sells.
Evidence
Has the molecule been tested for what it is sold for?
One row per product, graded on how far the published human evidence goes for the MOLECULE inside it, for the use it is sold for — not for the molecule in general, and never a claim about this seller. Nobody trials a compounded preparation; what a trial can tell you is whether the molecule has been tested for the thing it is being advertised to do. A molecule with phase 3 evidence for one outcome has none for another, and that distinction is where peptide marketing lives.
2
Molecules with human evidence
For the use they are sold for, out of 6 products reviewed here. The evidence belongs to the molecule, not to Willow.
3
Registry records cited
Each read live from ClinicalTrials.gov, never from memory. None of them tested this company's product.
The comparison
What they claim, against what the trials show
Each claim below is quoted word for word from Willow’s own page. Tap a row to see the quote, the trials behind it, and why it got that verdict.
Compounded semaglutide injection, once weeklySemaglutide · Compounded (503A)Claim reaches past the trials
“When stopping Semaglutide abruptly, some patients may experience mild to moderate weight gain. Others may maintain the weight loss they achieved while on the medication. [...] However, stopping Semaglutide is a safe and common practice that doesn't involve serious health risks.”
Read on the Willow site, September 2026
Phase 3 trials
What the trials show for Semaglutide
- NCT03548935 STEP 1 — Phase 3, completed, n=1,961. 68 weeks in 1,961 adults on semaglutide 2.4 mg with a lifestyle program. A one-year extension followed a subset after the drug was stopped.
STEP 1 is the one trial that watched what happens when semaglutide stops, and it answers Willow's sentence directly. In the extension, 327 people who had lost an average of 17.3% of their weight came off the drug. A year later they had regained 11.6 percentage points of it, about two-thirds. Most of the heart and blood-sugar improvements drifted back toward where they started. So mild to moderate regain is the typical result, not the unlucky one. Keeping it all off is what the trial did not find. Willow is right that stopping isn't dangerous in itself, and right to suggest a slow taper with your doctor.1,2
Compounded tirzepatide injection, once weeklyTirzepatide · Compounded (503A)Claim reaches past the trials
“When stopping Tirzepatide abruptly, some patients may experience mild to moderate weight gain. Others may maintain the weight loss they achieved while on the medication. [...] However, stopping Tirzepatide is a safe and common practice that doesn't involve serious health risks.”
Read on the Willow site, September 2026
Phase 3 trials
What the trials show for Tirzepatide
- NCT04184622 SURMOUNT-1 — Phase 3, completed, n=2,539. 72 weeks at 5, 10 and 15 mg once weekly. A body-scan substudy of 160 participants measured fat and lean mass separately.
- NCT04660643 SURMOUNT-4 — Phase 3, completed, n=783. After 36 weeks on tirzepatide, participants were randomized to keep going or switch to placebo for another 52 weeks.
SURMOUNT-4 tested exactly this. Everyone took tirzepatide for 36 weeks and lost an average of 20.9% of their weight. Then half were switched to placebo without knowing it. Over the next year, the placebo group regained 14% of their body weight, while those who stayed on the drug kept losing. So regain after stopping is the expected result, and keeping the loss is what happened to people who didn't stop. The same page also calls tirzepatide a GLP-1 drug that works like the body's own GLP-1, which undersells it: it acts on a second hormone receptor too, as the page says elsewhere.3,4
Compounded semaglutide tablet, dissolved under the tongue dailySemaglutide · Compounded (503A)No trial supports this claim
“Compound Semaglutide tablets are administered via daily doses under the tongue. They are a popular alternative for patients that are uncomfortable with self-injections. Sublingual medication works by placing the drug under the tongue, where it dissolves and is absorbed directly into the bloodstream through the tissues.”
Read on the Willow site, September 2026
No trial for this use
What the trials show for Semaglutide
No completed trial has tested semaglutide dissolved under the tongue. Searched ClinicalTrials.gov in September 2026 for sublingual semaglutide: two records. One is a small early-stage microdose study, still enrolling by invitation, with no results posted. The other is a heart and liver study in which the word refers to blood vessels under the tongue, not the drug. Every weight-loss result for semaglutide comes from a weekly injection or from the approved swallowed tablet, which needed its own absorption enhancer and its own trial program.
The claim that matters here is the one about absorption: that the drug dissolves under the tongue and reaches the bloodstream directly. No published study shows how much compounded semaglutide gets through that way, and Willow doesn't cite one. Semaglutide is a large peptide, and large peptides absorb poorly through the lining of the mouth. The approved oral version works only because it's swallowed with a specific absorption enhancer. Willow is candid elsewhere that no FDA-approved dissolving tablet exists. What it doesn't say is that nobody has measured whether this one delivers a useful dose.1
Compounded tirzepatide tablet, dissolved under the tongue dailyTirzepatide · Compounded (503A)No trial supports this claim
“Tirzepatide Tablets are a compounded prescription medication used to support medically guided weight loss. They work on both GLP-1 and GIP pathways, which help regulate appetite and feelings of fullness. As a daily oral dissolving tablet, they're designed to be placed under your tongue. No injections required.”
Read on the Willow site, September 2026
No trial for this use
What the trials show for Tirzepatide
No registered trial has tested tirzepatide under the tongue. A ClinicalTrials.gov search in September 2026 for sublingual tirzepatide returned no studies at all. Every tirzepatide weight-loss trial, SURMOUNT-1 included, used a once-weekly injection.
Tirzepatide's trial record is among the strongest in obesity medicine, and none of it was collected by this route. The page's description of how the drug works is accurate for the injection. Whether a daily tablet under the tongue delivers enough of a 39-amino-acid peptide to do the same thing has never been measured. Willow doesn't publish an absorption figure, and there's no trial to point to.3
Compounded semaglutide and tirzepatide combination tabletSemaglutide and tirzepatide · Compounded (503A)No trial supports this claim
“Semaglutide/Tirzepatide Combination Tablet* - $399–$459/month. Ask your doctor for more information.”
Read on the Willow site, September 2026
No trial for this use
No trial has given semaglutide and tirzepatide together, by any route. ClinicalTrials.gov held 73 records naming both drugs as interventions in September 2026. Every one compares the two, lets participants take either, or pairs one of them with something else, such as exercise. None combines them in one product.
Willow makes no efficacy claim for this product at all, which is the only defensible thing to say about it. It's two drugs that act on the same receptor, combined in a tablet that dissolves under the tongue, and neither the combination nor the route has been tested. The same guide says there are two tablet options and then lists three, so the combination reads like an afterthought. A reader offered it should ask why two GLP-1 drugs would be better than one, and what that answer is based on.
Compounded NAD+ injectionNicotinamide adenine dinucleotide (NAD+) · Compounded (503A)No trial supports this claim
“Support your body's natural energy production for steadier energy and clearer thinking, with many patients also noticing a brighter, more vibrant-looking complexion. Youthful energy that feels natural, not stimulated. Clearer thinking with less brain fog. A brighter, more vibrant-looking complexion.”
Read on the Willow site, September 2026
No trial for this use
No trial has tested injected NAD+ for energy, focus or skin in healthy adults. A PubMed search in August 2026 for NAD+ given by injection or infusion, limited to randomized trials, found one study that actually gave it: a week of low-dose infusions in people with heart failure from ischemic cardiomyopathy, measuring heart function. Nothing in that literature measures energy, thinking or complexion.
The biology on Willow's page is right: NAD+ is in every cell, it's central to making energy, and levels fall with age. None of that is the claim you'd be paying for. The claim is that injecting it three times a week gives you steadier energy, clearer thinking and brighter skin, and no trial has measured any of the three. The page also says the prescribed version delivers more consistent levels than a supplement, with no study attached to that either.6
Dispensing chain
Who actually fills your prescription
- Red Rock Home Pharmacy (Springville, Utah)
- Epiq Scripts LLC, dba Epiq Pharmacy (Richardson, Texas)
- Absolute Pharmacy (Lutz, Florida)
- The Pharmacy Hub (Miami, Florida)
- Empower Pharmacy (Houston, Texas)
Read the full account
Willow's terms list five partner pharmacies with street addresses and phone numbers, which is more than most of this market tells you. They don't say which one fills a given order. One of the five, Empower Pharmacy, received an FDA warning letter in September 2026 at the Houston address Willow prints. FDA said Empower compounded semaglutide and tirzepatide products that were essentially copies of the approved drugs, and that the prescriber notes justifying them were repeated word for word across many records. That letter is about the pharmacy, not about Willow. It matters here because Willow's product pages describe each formulation as personalized for you.
Read on the Willow site, September 2026.
Quality
Third-party testing, and what is published
Describes a testing regime
Nothing published on the pages searched
Certificate of analysis readable
No lot report a buyer can open
Read the full testing account
The injection and tablet pages say each batch of medication undergoes quality testing. No test result, certificate of analysis or testing lab is published to back that up. The compounding disclosure, by contrast, is thorough. Every product page says the drug isn't FDA-approved and isn't reviewed for safety, effectiveness or quality, and the footer adds that compounded medications aren't brand-equivalent.
Read on the Willow site, September 2026.
Licensing
Licensed to dispense, and where
Coverage
Willow's FAQ lists 36 states it serves, including California, Florida, New York and Texas. Its about page lists 12 it doesn't serve yet. New Mexico and Vermont appear on neither list, so check at signup if you live there.
Read the full licensing claim
The operating company is Willow Health Services, Inc. of Houston, named in its terms. Doctors come through an affiliated medical practice the terms define but never name. The practice's president, Dr. Michael Green, is Willow's chief medical officer and holds an equity interest in the company, which the terms disclose.
Named as outside that footprint
Read on the Willow site, September 2026.
Regulatory
The FDA warning letter
No FDA warning letter found
Assessment
What holds up, and what does not
- It publishes a price for every dose, so you can see the cost at the top of the ladder.
- Its terms name five partner pharmacies with addresses and phone numbers.
- Every product page says plainly that compounded drugs aren't FDA-approved or brand-equivalent.
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- It discloses that its chief medical officer holds equity in the company.
- Its tablet guide says outright that no FDA-approved dissolving tablet exists.
- It publishes a list of the states it serves.
- No FDA warning letter to Willow itself.
- It says some people keep the weight off after stopping; STEP 1 found most regained two-thirds.
- Its help center says these drugs aren't linked to muscle loss; SURMOUNT-1 measured that they are.
- No trial has tested semaglutide or tirzepatide dissolved under the tongue.
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- It sells a two-drug combination tablet that no trial has ever tested.
- One of its five named pharmacies got an FDA warning letter in September 2026.
- It says each batch is quality-tested and publishes no results.
- Its tablet guide and its price list quote different prices for the semaglutide tablet.
Verdict
The bottom line
If you want to know what a year really costs, Willow is one of the few sellers that shows you. At the top tirzepatide dose it's $549 a month, and the page says so. Go in knowing two things its pages get wrong. Most people who stop these drugs regain much of the weight. And some of what you lose will be muscle, which is a reason to keep up protein and strength work, not a reason to panic.
Opens Willow's website. A link is not a recommendation to take anything.
It shows you the whole ladder
Most sellers print a starting price and stop. Willow's help center has a price for every dose.
- Semaglutide injection: $299 a month up to 3.5 mg, $399 at 7 mg.
- Tirzepatide injection: $399 through 6.375 mg, $499 at 8.5 and 11 mg, $549 at 17 mg.
- NAD+ injection: $199 a month.
Its terms say the fee can go up with a dose increase. Here, at least, you can see by how much before it happens.
Full analysis — 4 more sectionsWhat it says about stopping · What it says about muscle · The tablets · The pharmacies
What it says about stopping
Every product page carries the same paragraph:
"Some patients may experience mild to moderate weight gain. Others may maintain the weight loss they achieved while on the medication."
STEP 1 is the trial that checked. 1 People who stopped semaglutide after losing 17.3% of their weight had regained about two-thirds of the loss a year later. 2 SURMOUNT-4 did the same test for tirzepatide, and people switched to placebo regained 14% of their weight. 4
Willow's advice to taper slowly with your doctor is sensible. The suggestion that keeping it all off is a common outcome is not what either trial found.
What it says about muscle
From its help center:
"There's no inherent association between the use of these medications and muscle loss."
SURMOUNT-1 scanned body composition in 160 people. 5 On tirzepatide, about a quarter of the weight lost was lean mass. That share was the same on placebo, so the drug isn't unusually hard on muscle. But weight loss does take some muscle with it, and a reader told otherwise has no reason to protect it.
The tablets
Willow sells both drugs as tablets you dissolve under your tongue, plus a tablet combining the two. It says honestly that no FDA-approved dissolving version exists.
What it doesn't say is that no trial has measured how much drug gets through this way. No registered study has tested tirzepatide under the tongue at all, and no completed one has tested semaglutide. The combination has never been tested by any route.
The pharmacies
Willow names five. One is Empower Pharmacy in Houston, which received an FDA warning letter in September 2026. 7 FDA said Empower compounded products that were essentially copies of approved semaglutide and tirzepatide, backed by prescriber notes repeated word for word across many records. Nothing says which of the five fills your order.
Questions
Frequently asked questions
What does Willow cost at higher doses?
Semaglutide injection is $299 a month up to 3.5 mg and $399 at 7 mg. Tirzepatide injection is $399 through 6.375 mg, rising to $549 at the 17 mg top dose. Willow publishes the full ladder on its help center, which few sellers do.
Will I keep the weight off if I stop?
Probably not all of it. Willow's pages say some patients maintain their loss, but STEP 1 found people regained about two-thirds of it within a year of stopping semaglutide, and SURMOUNT-4 found similar regain on tirzepatide. Plan the exit with your doctor before you start.
Will I lose muscle on these drugs?
Some, yes. In SURMOUNT-1's body-scan substudy, about a quarter of the weight lost on tirzepatide was lean mass, the same share as on placebo. Willow's help center says there's no link, and that's not what the trial measured.
Do the under-the-tongue tablets work as well as injections?
Nobody knows. No registered trial has tested tirzepatide that way, and no completed trial has tested semaglutide. Every weight-loss result for both drugs comes from injections or, for semaglutide, an approved swallowed tablet that uses a special absorption enhancer.
Which pharmacy makes Willow's medication?
Willow's terms name five: Red Rock Home Pharmacy, Epiq Pharmacy, Absolute Pharmacy, The Pharmacy Hub and Empower Pharmacy. They don't say which fills a given order. Empower received an FDA warning letter in September 2026.
Is the doctor independent of the company?
Not entirely. According to Willow's terms, the president of its affiliated medical practice is also its chief medical officer and holds equity in the company. Few sellers disclose a tie like that at all.
Glossary
Key terms
Show definitions
- Compounded
- Made to order by a pharmacy for an individual patient rather than manufactured and approved as a finished product. Compounded drugs are not FDA-approved and the FDA has not evaluated their safety, effectiveness or quality.
- STEP 1
- The phase 3 trial of once-weekly semaglutide 2.4 mg for weight loss: 1,961 adults over 68 weeks, with a one-year follow-up after the drug was stopped.
- SURMOUNT-4
- The phase 3 trial that tested what happens when tirzepatide is withdrawn: after 36 weeks on the drug, participants either continued or switched to placebo for a year.
- Lean mass
- Everything in the body that isn't fat, including muscle, organs and water. Body-composition scans in weight-loss trials report it separately from fat mass.
Compare
Others selling what Willow sells
Companies we have also reviewed that dispense at least one of the same compounds, ordered by how much of what they say about their products matches the trials behind them. Nothing here is a recommendation, and none of these links earns us anything.
Ranked
The lists Willow is on
Method
How we checked this
Non-product facts last checked September 2026. Read the editorial policy for the rules this page is held to.
Read our methodology
Claims read first-party
Every quoted claim was read off Willow's own pages, first-hand, on the date stamped against it — never from a summary, an aggregator, or an earlier version of this review.
Trials read from the registry
Phase, status and enrollment come from ClinicalTrials.gov; identifiers and journals from PubMed's own records. Nothing here is cited from memory.
Absence claims bounded
Where we report that no trial exists, the page says what was searched, where, and when — never an unbounded claim that nobody has tested something.
Letters matched on full name
FDA letters are matched on the complete company name. A substring match would attach one firm's regulatory history to another with a similar name.
Sources
References
Show all 7 sources
- Wilding JPH, Batterham RL, Calanna S, et al. (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. New England Journal of Medicine. https://pubmed.ncbi.nlm.nih.gov/33567185/
- Wilding JPH, Batterham RL, Davies M, et al. (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism. https://pubmed.ncbi.nlm.nih.gov/35441470/
- Jastreboff AM, Aronne LJ, Ahmad NN, et al. (2022). Tirzepatide Once Weekly for the Treatment of Obesity. New England Journal of Medicine. https://pubmed.ncbi.nlm.nih.gov/35658024/
- Aronne LJ, Sattar N, Horn DB, et al. (2024). Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA. https://pubmed.ncbi.nlm.nih.gov/38078870/
- Look M, Dunn JP, Kushner RF, et al. (2025). Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight. Diabetes, Obesity and Metabolism. https://pubmed.ncbi.nlm.nih.gov/39996356/
- Yu X, Xu J, Cao J, et al. (2026). Effect of Nicotinamide Adenine Dinucleotide on Heart Failure Caused by Ischemic Cardiomyopathy: A Randomized, Placebo-Controlled Trial. American Journal of Cardiovascular Drugs. https://pubmed.ncbi.nlm.nih.gov/40954388/
- US Food and Drug Administration (2026). Warning Letter to Empower Clinic Services, LLC dba Empower Pharmacy, MARCS-CMS 738238. FDA. https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/empower-clinic-services-llc-dba-empower-pharmacy-738238-09182026
Medical disclaimer: This content is for general educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a licensed healthcare professional before starting, stopping, or changing any treatment.